05/05/2016    Paul Kesselman, DPM

Source for Size 18E SADMERC-Approved Shoes (Sharon Root, DPM)

Before answering your question, let me provide
some background information to assist you with
your query:

A) SADMERC was replaced by CMS many years ago
with the Price Data Analysis Contractor (PDAC)
which essentially performs the same functions
as SADMERC;

B) SADMERC did away with the requirement(s) for
product reviews and validation prior to its
dissolution and the PDAC has continued that
practice. That is, therapeutic shoes do not
require a product validation as part of the
Therapeutic Shoe for Patients with Diabetes
(TSPD) program. However, they must meet the
specifications for shoes which are stated in
the policy (must be available in 3 widths,
etc.). The inserts are another story. So this
patient may now require custom inserts, but
since these are made from raw materials, any
distributor of stock shoes who also provides
custom inserts should be able to assist you.

That being said, you have three choices to
resolve this matter:

1) Find any shoe which comes in a size 18E. As
long as that shoe meets the specification found
in the policy, you should be fine. You should
be able to obtain the specification from the
mfg. I would search the usual websites which
most consumers utilize in order to do some
research such as Amazon, Zappos etc. in order
to assist you. Many years ago I had a similar
situation with a 12 year old female who wore a
size 15 shoe. I had the parents reach out to
the NY Liberty (WNBA team) whose marketing
director assisted them in their quest for
fashionable shoes for this patient. You may
wish to reach out to college or professional
sports teams in your area for similar
referrals.

2) Punt this to a local pedorthic facility who
likely has the purchasing power to deal with
companies such as Nike and others which won't
wholesale to you.

3) Should the above prove impossible, your last
option is to have the patient casted for a
custom fabricated shoe. Documentation to
prove medical necessity is that the patient due
to their deformities and the size of foot could
not be accommodated by a stock extra depth
shoe. You could state your inability to obtain
such a shoe from many wholesalers. If you don't
provide custom fabricated shoes, then again a
referral to someone who can would be
appropriate.
I'll be interested in how this is resolved.
Please keep us informed.

Paul Kesselman, DPM, Woodside, NY

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